Worth the risk?

Hormone replacement therapy brings relief along with the threat of stroke, heart attack and cancer

Hormone replacement therapy has been on a roller coaster of popularity over the last few decades, often taking women like Linda Patterson on a wild ride of confusion, discomfort and frustration.

Prescribed hormones nearly 20 years ago for hot flashes, night sweats and vaginal dryness, her doctor enthusiastically said the daily estrogen/progestin pill would “make me feel better, look better, sleep better, and I’d have a great sex life again,” said the 68-year-old Carlsbad woman. “And, for the most part, he was right.”

Then, a little more than 10 years ago, Patterson’s doctor abruptly told her to stop using the hormones she’d come to rely on to make her feel so good. In 2002, the Women’s Health Initiative, the largest government-sponsored clinical trial to evaluate hormone therapy for disease prevention, found disturbing results. The popular combination estrogen/progestin therapy was found to increase the risk of stroke, heart attack, blood clots and breast cancer.

“The news scared me, so I stopped taking my hormones and in just days I was miserable again. The hot flashes returned, I was up all night with the sweats, and I was really irritable,” Patterson said.

After almost a year of toughing it out, she’s back on hormones, now using a lower-dose transdermal patch instead of a pill.

“I feel better, but now I worry about the (harm) I might be doing to my health. I wonder if it’s all worth the risks,” she said.

Patterson’s not alone in her dilemma.

According to Dr. John Willems, chief of the obstetrics and gynecology department at Scripps Clinic, 15 percent of women never have menopausal symptoms, 15 percent of women never stop having menopausal symptoms and 70 percent of women have symptoms some time and then the symptoms stop. That leaves a lot of women very uncomfortable for at least some of their lives.

Some of those who dutifully gave up their pills 10 years ago have started taking them again, driven back by sleepless nights, hot flashes, mood swings, mental fuzziness and a plummeting libido.

Today, one in five postmenopausal American women uses hormone replacement therapy, mostly to treat common menopausal symptoms. That’s about half the rate in 2002, when 40 percent took hormones, according to the North American Menopause Society.

Other women, who are still HRT reluctant, are experimenting with alternative treatments, including herbal supplements, homeopathy, customized creams and antidepressants.

San Diego gynecologists answer some often-asked questions from women about hormone replacement therapy:

Q: Millions of women stopped taking hormones as a result of the Women’s Health Initiative study 10 years ago. Did we overreact?

A: “I think women did panic, but the way the (study’s) data was publicized I can understand why there was panic and confusion,” said Dr. Kathryn Macaulay, an ob/gyn and head of the Integrative Menopause Health Program at University of California San Diego Medical Center. “This was the largest-scale study on hormone replacement therapy, and the results were surprising.”

Although the pendulum may have swung too far to the conservative side, a number of doctors say it was a good thing that many women who were inappropriate candidates for hormone replacement stopped.